preexisting condition
Also called: penyakit bawaan, kondisi awal
A condition that already exists before the policy is active and is usually limited or excluded.
What it means
A preexisting condition is a health condition that already exists before the insurance policy takes effect. The insurer usually asks for disclosure of health history at enrollment. This condition may be excluded, subject to a waiting period, or accepted with a different premium. In Indonesia, this term is also called congenital disease or initial condition.
Why it matters for families
Hiding a preexisting condition at enrollment can cause claims to be denied later. Conversely, disclosing honestly helps the family know what is truly covered. If a preexisting condition is excluded, the family needs to prepare their own funds for its treatment. Honesty upfront protects claims in difficult times.
Example
For example, someone already has a history of high blood pressure before buying a policy. The insurer may apply a waiting period or exclusion related to that condition. If the condition is not disclosed, related claims can be disputed.
Common misunderstanding
Some people think preexisting conditions are always automatically covered as long as premiums are paid. The correction is that many policies exclude or limit conditions that existed before the policy took effect.